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This encounter is being recorded

Better not bring your smartphone or pocket-size digital recorder to Dr. David Troxel’s office – and don’t even think about recording your conversation with the doctor so you can remember the details later.

In a guest entry last week at Kevin MD, Dr. Troxel, the chief medical officer for a physician liability insurer, took issue with the practice of bringing a recorder into the doctor’s office:

It is understandably tempting for patients to record consent discussions, medication and follow-up instructions, and other physician and staff interactions.

Recording a medical discussion via video or audio is no proxy, however, for paying attention, and the practice puts you and your office at significant risk.

Video or audio recording should not be allowed in the office setting. It breaches the confidentiality rights of the other patients and infringes on the privacy rights of the physician and employees.

His recommendation to medical practices: Post a sign prohibiting the use of recorders and urge patients to take written notes instead.

It seems to be only a matter of time before someone records a scene in the waiting room or a visit with the doctor or nurse practitioner and posts it on YouTube for the whole world to see. To some extent this is already happening with videos of labor and delivery (and creating a whole set of questions about ethics and patient safety, but that’s a topic for another day). In this sense, the privacy issues wrought by technology are very real.

But not allowing patients to tape their encounter with the doctor to help them remember afterwards?

Many experts in the field of patient advocacy see recordings as a very useful tool for prompting the patient’s memory and helping them recall details of the conversation they may have missed. Most people do not in fact absorb everything that’s said during the encounter, especially if they’re anxious, stressed or have just received a life-changing diagnosis.

Numerous studies over the years have examined the patient’s ability to recall what was said during the visit, and most of these studies have found significant gaps – both in how much patients remembered and how accurately they remembered it. One study, published earlier this year in the Family Medicine journal, found that one-third of the patients in a sample group who received a new prescription during an outpatient visit forgot at least some of the information the doctor gave them.

Conversely, in a Scottish study last year on the quality of informed consent for patients about to undergo heart surgery, patients who received an audiotape of the consultation with the heart surgeon had a better understanding of the procedure and felt more in control.

And check out the feedback on a project being undertaken at the Oliver Center for Patient Safety and Quality Healthcare, at the University of Texas Medical Branch in Galveston, to provide patients with tape recorders to use during office visits: “I forget a lot so this has been really good for me.” “This is helpful since my hearing is poor and my wife’s memory is bad.” “Makes my kids feel involved.”

There’s nothing wrong with inviting patients to take notes the old-fashioned way, via paper and pen. But many people don’t have good note-taking skills, and some patients may not be literate enough to take adequate notes during a doctor visit. A recording can address all these issues in one fell swoop.

The down side is that, like any other technology, the use of recorders in the doctor’s office can create problems of its own. Their presence sometimes has a way of inhibiting the conversation, which may not be in the patient’s best interests. Nor does it guarantee the patient will be more informed or receive better care; this still depends to a great extent on the quality of the encounter itself.

What about the privacy issue, which seemed to be Dr. Troxel’s main concern? As long as one party has consented, audio recording is considered legal in most states. It seems to be generally agreed, however, that if patients want to record their doctor visit, they should do so openly and ask for permission first.

Which brings us back to where we started: how best to use a technology that clearly benefits patients but also might be misused. It seems there’s a deeper issue here and it isn’t merely about the technology; it’s about doctor-patient trust and how this is helped or hindered by allowing patients to record their visit with the doctor. If Dr. Troxel believes patients can’t be trusted to use the technology appropriately, what does that say about his attitude toward patients in general? And if patients feel they need to surreptitiously record their visit with the doctor, what does that say about the relationship?

There may be times when recording isn’t appropriate, but on the whole it seems far better to err on the side of openness than to yank away the usefulness that audio recording can bring to the encounter.

What do readers think? Should recording the doctor visit be encouraged or should it be banned? Have you ever recorded a doctor visit – and if so, was it helpful?

3 thoughts on “This encounter is being recorded”

Never thought to bring a recorder to doctor’s office myself, but I’ve sometimes asked them to write something down for me so I don’t mix up the details. I do have a real problem with not being able to keep up with a conversation when trying to take notes. Thus I have a voice recorder I bring to some meetings at work. I can see where doctors might be reluctant to allow recordings if they fear it will be used against them later on. That being said, if I had a doctor that refused to allow recordings, I’d remind him he works for me, not vice versa. I’d also ask for a different doctor. I don’t need a lot of attitude from somebody I’m supposed to trust.

I appreciate your thoughtful treatment of this topic and the thorough rebuttal to Dr. Troxel’s stance that patients shouldn’t record doctor’s visits. I recorded a visit with my doctor just yesterday, using an application on my smart phone that allows me to record the visit and then upload it to a secure website. The website and app are called CareCoach (www.CareCoach.com) and were developed by my company. My doctor didn’t bat an eye when I asked if I could record the visit, and I found it reassuring to know that I could refer back to the recording later, particularly since we were discussing multiple issues and she had a list of instructions for me. While I’m not in favor of stealth recording, it seems that doing so in the open, with everyone’s consent, can only be beneficial.

The issue is too one sided. What about having the physician or nurse record the conversation and offer a copy to the patient? For one thing, you could avoid the problem of the physician’s paying more attention to the computer than to the patient. For another, as has been stated, patients only recall a small percentage of what was said in the interview, and helping patients remember the advice and the instructions given by the physician can only be helpful. Of course there is another side. That is when third parties start critiquing the office notes and find a recording in which something is said that displeases the reviewer. That can indeed be intimidating and encouraging to fewer words and more carefully selected diction. This needs further review and actually should be tried out under controlled circumstances to see what happens.